Pubdate: Thu, 18 Mar 1999 Source: Richmond Times-Dispatch (VA) Copyright: 1999, Richmond Newspapers Inc. Contact: 804-775-8072 Website: http://www.gateway-va.com/ Author: A.j. Hostetler, Times-Dispatch Staff Writer MEDICAL ROLE FOR POT IS SEEN Report Urges Clinical Trials Of Marijuana The latest federal report on marijuana's medical uses calls for further study so that patients suffering from pain and nausea can benefit from pot's active ingredients without inhaling its smoke. The Institute of Medicine report, which likely will reignite the debate over marijuana, says there is no conclusive evidence that smoking pot leads to using harder drugs. The report, released yesterday, says that because the chemicals in marijuana ease anxiety and pain, stimulate the appetite and reduce nausea and vomiting, they can help people undergoing chemotherapy or those with AIDS. "This report says that under certain circumstances, in chronic patients, that medical marijuana has a role, and we should conduct clinical trials to determine its efficacy," said Dr. Billy Martin of Virginia Commonwealth University, who served as an adviser for the report. "Just like we've done with anything else." The report stresses that it is marijuana's active ingredients, the cannabinoids, not the plant itself, that have medicinal value. "Marijuana has potential as medicine, but it is undermined by the fact that patients must inhale harmful smoke," said one of the report's editors, Stanley Watson of the University of Michigan. Smoking pot should be recommended only for terminally ill patients or for those who do not respond to other treatments, the report says. The report was commissioned in 1997 by the White House Office of National Drug Control Policy as a review of research on marijuana's medicinal uses. It does not address legalization. It comes 17 years after the first federal scientific report on marijuana and 18 months after the National Institutes of Health concluded that there are too few scientific studies to determine marijuana's therapeutic utility, but that research into its medical uses was justified. The drug control office said it would examine the recommendations. "We note in the report's conclusion that the future of cannabinoid drugs lies not in smoked marijuana, but in chemically defined drugs" delivered by other means, the office headed by retired Gen. Barry McCaffrey said in a statement. The report urges clinical trials to determine the usefulness of marijuana in treating muscle spasms. It also urges development of standardized forms of marijuana's cannabinoids that patients can easily use, such as inhalers. Marinol, a drug based on marijuana's psychoactive ingredient, THC, already is on the market. It is federally approved to treat nausea and vomiting associated with chemotherapy, as well as the anorexia and wasting AIDS patients often suffer. However, marijuana advocates say it doesn't work as well as the real thing. While smoked marijuana also has been promoted as a treatment for glaucoma, the report says it only temporarily reduces some of the eye pressure associated with the disease. Glaucoma often has been cited by marijuana advocates as benefiting from smoked pot. Despite claims by opponents of marijuana's medical uses that pot is a "gateway" drug leading to more dangerous drugs such as heroin and cocaine, the report concludes that there is no such evidence. In fact, the report says, most drug users did not begin with marijuana but started by using tobacco and alcohol while they were underage. The New England Journal of Medicine has editorialized in favor of medical marijuana, and the American Medical Association has urged the federal National Institutes of Health to support more research on the subject. VCU's Martin, who has spent the past two decades studying marijuana, its effects on the brain and how and to what extent users become dependent, said he expects the report and its recommendations to be controversial because of the stigma attached to research on illegal drugs. "It could be that [the report] will give the NIH some cover for supporting some clinical trials," he said. Such studies "are not a politically positive thing to do," given that passions run high among marijuana's advocates and critics. Congress, for example, has taken a hard line on the issue, with the House last fall adopting by 310-93 a resolution that said marijuana was a dangerous and addictive drug and should not be legalized for medical use. There is some political support for the legal medical use of marijuana. Voters in Alaska, Arizona, California, Colorado, Nevada, Oregon and Washington recently approved measures in pot's support. In Virginia, a 1979 law allows the use of marijuana for medical purposes, although federal law still bans its use. The Drug Free American Foundation, based in St. Petersburg, Fla., opposes voter referendums on marijuana, saying that pot's medical use and research should be determined by its proven scientific value. "This is not a voter issue," said Katherine Ford, a spokeswoman for the group. "Let's see the science on this." One patient, a former Virginian whose doctor prescribed pot to relieve his pain, called the findings long overdue. "It's taken a long time, but I feel like now, people will stand up and listen," said Irvin Rosenfeld, a stockbroker in Boca Raton, Fla., and one of just eight people in the country receiving marijuana from the government because of unusual diseases. "When you have a devastating disease, all you care about is getting the right medicine . . . and not having to worry about being made a criminal," Rosenfeld said. He suffers from tumors that press into the muscles at the end of long bones. The marijuana relaxes those muscles, keeping them from being torn by the tumors and allowing him to move with less pain. Rosenfeld's illness was diagnosed in 1979, when he lived in Portsmouth. The Institute of Medicine, an affiliate of the National Academy of Sciences, provides the federal government with independent scientific advice. - --- MAP posted-by: Richard Lake